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www.ncbi. nlm.nih.gov/ pubmed/15468362? ordinalpos=
3&itool=EntrezSystem2 .PEntrez. Pubmed.Pubmed_ ResultsPanel.
Pubmed_DefaultRe portPanel. Pubmed_RVDocSum J Rheumatol. 2004 Oct;31
(10):1973- 80. Links
Doxycycline versus doxycycline and rifampin in undifferentiated
spondyloarthropathy , with special reference to chlamydia-induced
arthritis. A prospective, randomized 9-month comparison.
Carter JD, Valeriano J, Vasey FB.
Division of Rheumatology, University of South Florida, Tampa,
Florida 33612, USA. jocarter@hsc. usf.edu
OBJECTIVE: Chlamydia is a known trigger of reactive arthritis (ReA).
It may also be common cause of undifferentiated spondyloarthropathy
(uSpA). Persistent, metabolically active, Chlamydiae have been
observed in the synovial tissue of these patients years after their
initial exposure. Trials with lymecycline and rifampin have shown
benefit in early/acute Chlamydia-induced arthritis. In vitro data
suggest that persistent Chlamydia become resistant to chronic
monotherapy of tetracyclines or rifampin, whereas no such resistance
is noted when rifampin is added to antimicrobials that are active
against Chlamydia. Rifampin and doxycycline also show synergistic
effect against Chlamydia.
In addition, rifampin inhibits chlamydial production of heat shock
proteins (HSP). HSP60 plays a key role in the chronic persistent
state of Chlamydia. We conducted a prospective, randomized 9-month
trial to evaluate the efficacy of doxycycline versus a combination
of doxycycline and rifampin in the treatment of uSpA.
METHODS: The study enrolled 30 patients with chronic inflammatory
arthritis (average disease duration 10 yrs) who fulfilled the
European Spondylarthropathy Study Group criteria, with no evidence
of inflammatory bowel disease, psoriasis, ankylosing spondylitis, or
preceding dysentery. Patients received doxycycline 100 mg po twice
daily or a combination of doxycycline 100 mg po twice daily and
rifampin 600 mg po daily. They received a 4-question self-
questionnaire and a blinded joint examination at each visit. The
questions include a visual analog scale (VAS) for their current
amount of back pain, duration of morning stiffness, back pain at
night, and peripheral joint pain. The blinded joint examination
consisted of a swollen joint count (SJC) and a tender joint count
(TJC). These 6 variables were assessed at baseline and at 1, 3, 6,
and 9 months. Responders were defined as those who improved > or =
20% in at least 4 of the 6 variables at 9 months of therapy.
RESULTS: Comparing the doxycycline + rifampin arm (D/R) versus the
doxycycline arm (D) at 9 months of therapy, all 6 variables improved
more in D/R versus D, 4 of which were statistically significant. The
mean VAS (scale of 100) decreased 24.4 points in D/R in contrast to
3 points in D (p < 0.03). Duration of morning stiffness decreased by
1.2 h in D/R, with a slight increase of 0.1 h in D (p < 0.003). The
back pain at night and peripheral joint pain both improved in D/R
group versus D (not statistically significant) . Finally, the SJC
and TJC also improved in D/R (-2.1 and -2.5) versus D (-0.4 and -
0.6; p = 0.02, p = 0.03, respectively) . Eleven of 15 patients in
the D/R arm were responders, whereas only 2 of 15 D group patients
were considered responders (p < 0.003).
CONCLUSION: The combination of doxycycline and rifampin for 9 months
seemed to be effective in treatment of chronic uSpA. This is the
first study to demonstrate therapeutic benefit with antimicrobials
to a chronic inflammatory arthritis possibly secondary to persistent
Chlamydia.
PMID: 15468362 [PubMed - indexed for MEDLINE]
